ELELYSO 200 UNITS VIAL (1 EA ) (NDC: 00069010601)
2014 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Additional Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
HumanaChoice R5826-006 P (Regional PPO)
|
$30.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:350 /30Days | $705.06 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
McLarenAdvantage (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $693.17 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$54.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $719.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-005 (PFFS)
|
$80.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:350 /30Days | $705.06 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare (HMO-POS)
|
$123.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
McLarenAdvantage (HMO)
|
$128.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $693.17 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $700.67 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $719.25 |
Browse Plan Formulary |